| NPI | 1528563897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY JOHNSON Contracts Specialist 864-527-3145 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2019-05-17 |